ConnectionSpring 2011 • Volume 18, No. 1 Hospital for Special Surgery’s Good Health Newsletter

Health

Contents1 Osteoarthritis 101:

The Basics

2 Reducing Your Risk of Osteoarthritis

3 Athletes: Cross-Train toReduce Arthritis Risk

6 When It Comes to Arthritis, It’s Ladies First

7 HSS Leads in Advancing the National ArthritisAgenda

HOSPITAL FOR SPECIAL SURGERY

Osteoarthritis 101: The BasicsMary (Peggy) K. Crow, MDPhysician-in-Chief; Chair, Division of Rheumatology Professor of Medicine, Weill Cornell Medical College

There are steps you can take, even starting today, toreduce your risk of developing the condition if youdon’t have it, and to live with less pain if you do. In-corporating physical activity into your daily routineand adopting healthy eating habits to achieve ahealthy weight are excellent first steps. Hospital forSpecial Surgery offers guidance and treatment to getyou on your way.

What Is Osteoarthritis?In its simplest terms, osteoarthritis involves the break-down of cartilage in your joints — most commonly inthe knees, hips and hands. This spongy tissue nor-mally acts as a shock absorber between the bones ineach joint. But over time, and particularly with age orinjury, the cartilage breaks down due to normal wearand tear. In early-stage osteoarthritis, the cartilage hasstarted to deteriorate, but the bones are unaffected.

As years pass, the bones lose this protective cush-ion, and they can rub against each other, causing thepain that characterizes osteoarthritis. This progressionmarks the later stage of the disease.

Arthritis specialists are increasingly learning thatthere’s more to the story than wear and tear: inflam-mation appears to play a role as well. Studies haveshown that many people with osteoarthritis have in-flammatory cells in their joints, especially among thosewho have suffered an injury (such as a torn meniscusor anterior cruciate ligament in the knee) that puts themat an increased risk for developing osteoarthritis.

Research is demonstrating that in addition to me-chanical damage to a joint, an individual’s responseto that damage may influence the onset of os-

teoarthritis. And if doctors can understand what fac-tors promote arthritis progression, they might be ableto intervene earlier — such as by guiding patients tohelp them lose weight. With more research, we mighteven be able to define medical approaches that wouldprevent progression of joint damage.

Who Is at Risk?While osteoarthritis can affect anyone, there are somerisk factors that can increase your chance of devel-oping the condition:

Our Education MissionThe Education Divisionat HSS is committed tobeing the source foroutstanding initiatives in education, training, research and informa-tion for local, nationaland international com-munities to prevent andtreat musculoskeletalconditions.

Osteoarthritis is a disorder that affects the lives of 27 million Americans. It triggers pain in the jointsthat limits mobility and daily activities, potentially turning mundane tasks such as buttoning a shirt orwalking the dog into an endurance test. The disease is the nation’s number one musculoskeletaldisorder. Many impacted by it suffer because they are unaware of the broad range of innovativetreatment options available to help them.

Programs PromotingMusculoskeletal Health continued on page 4

Step 1: What Are You Eating?Obesity is the leading cause of os-teoarthritis. Being overweight puts extraor-dinary stress on weight-bearing joints, suchas the knees and hips. Did you know thatfor every pound of weight you lose, you canachieve a four-pound reduction in the loadyou exert on each knee every time you takea step during your daily activities? So if youlose 10 pounds, you reduce the stress oneach of your knees by 40 pounds! If youare overweight, losing 5 to 10 percent ofyour body weight may reduce your risk ofdeveloping arthritis.

The best ways to achieve and maintaina healthy weight are to adopt healthy eatinghabits and to incorporate physical activityinto your routine. Aim for a diet high in fruits

and vegetables (five to nine servings a day,of which five or more are from veggies), highin fiber and whole grains, and low in fat.

It’s best to be patient. Weight loss isbest sustained when the weight is lost grad-ually. Aim to lose one to two pounds perweek. It may have taken you years to accu-mulate those pounds, so don’t be surprisedif it take several months to lose them.

Likewise, don’t expect your diet tochange overnight. Start by looking at whatyou are eating now (keeping a food diary isa great way to do this) and identifying areaswhere you can improve. Little steps alongthe way will add up to big results over time.

Studies have shown that in populationswhere the diet contains lots of foods withantioxidants and omega-3 fatty acids, the

prevalence of obesity and osteoarthritis arelow. Foods that are high in these nutrientsinclude: berries, fatty fish (including salmon),citrus fruits (such as oranges or grapefruit),and orange and yellow vegetables (for ex-ample, peppers).

Here are five things you can do today tostart eating healthier:

1 Replace your daily bagel andcream cheese with a whole wheatEnglish muffin with 2 tablespoonsof peanut butter.

2 Eat an apple with your breakfast, and plan to add at least one serv-ing of fruits or vegetables at lunchand dinner.

3 Bring your lunch to work instead of buying it. Try turkey and lettuceon whole grain bread with mustardand carrots or celery sticks withhummus on the side.

4 Broil seasoned, skinless chickenfor dinner instead of frying skin-covered chicken.

5 Switch to fat-free milk or taper downfrom whole milk to 2 percent to 1 per-cent before gradually going to fat-free.

The key to success is to make changesslowly, finding a diet that you can live withand won’t abandon. If you are finding itdifficult to get started, a registered dietitiancan work with you to show you how.

Step 2: Start Moving!“Moving is the best medicine.” That’s thetheme of a national osteoarthritis awarenesscampaign launched by the Arthritis Founda-

2 | HealthConnection

Reducing Your Risk of OsteoarthritisSotiria Everett, MS, RD, CDN, CSSD | Clinical Nutritionist, Department of Food and Nutrition ServicesMichael Silverman, PT, MSPT | Physical Therapist, Rehabilitation Department

Millions of Americans have osteoarthritis, and its prevalence continues to increase asthe population ages. The good news is that there are steps you can take to reduceyour risk of developing osteoarthritis. While it’s true that you can’t change your genesor your age, you can achieve and maintain a healthy weight, build muscle strength,and increase your flexibility…all of which are great ways to help prevent arthritis.

continued on page 7B

HealthConnection | 3

The answer is cross-training. It’s good togive your body a rest and switch to other ac-tivities from time to time. If you run, for ex-ample, take a day off every now and thenand do something else, like work out on anelliptical trainer or bike. Also, during thesame exercise session, it’s best to incorpo-rate numerous small workouts (rather thanjust one long workout) to target all the majormuscle groups. Taking a break from thesame repetitive motions that exert a heavyload on your joints reduces stress and givesyour joints a chance to rest.

In athletes — both professionals and am-ateurs — the risk of osteoarthritis rises withcertain movements and injuries. For example:

• The risk of osteoarthritis in the kneeclimbs if you experience an injury to ananterior cruciate ligament (ACL) and/orto the meniscus — even if you have hadit surgically repaired. Knees that are un-stable due to an injured ACL becomemore prone to arthritis. When themeniscus becomes damaged or is re-moved, it increases the stress on thecartilage in the knee and promotesarthritis. Blood in the knee during suchan injury also causes pain and swelling.

• Activities that are associated with fric-tion between the bottom of the shoe andthe sports surface may also placehigher loads on the knee. For example,hard tennis courts, artificial turf and bas-ketball courts can all cause friction onthe shoe and exert more stress on thejoints. Similarly, running on a synthetictrack, dirt or gravel is better for the jointsthan pounding the pavement.

• Repetitive twisting, such as that in golfor baseball, may exacerbate the loadplaced on hips, knees and shoulders.

Professional baseball players, for exam-ple, place extraordinary stress on theirhips when practicing batting, and on theirshoulders during pitching.

• Sports that cause repetitive falling duringtraining, such as competitive gymnasticsor figure skating, often cause acute in-juries that may raise the risk of hip andknee arthritis over time.

If you’re active or interested in pursuingan exercise program to reduce your os-teoarthritis risk, congratulations! Just followthese tips to stay safe:

1 Include weight-training in your regi-men. Strong muscles do a better job ofsupporting joints than weak muscles.There’s no need to pump serious iron:use low weights with a high number ofrepetitions to get the best results.

2 Learn how to land properly. If you areinvolved in a sport that requires a lot ofjumping, like basketball or volleyball,learn how to land so pressure isplaced more evenly on the knees, re-ducing the risk of injury.

3 Be sure to stretch gently before ex-ercising to keep muscles, tendonsand ligaments supple. You canstretch afterward as well.

4 Replace athletic shoes when theylose their ability to provide adequatesupport and shock absorption, whichis usually after a few hundred miles ofwear or when you see an unevenwear pattern.

5 Incorporate no-impact activities(such as swimming or cycling) or low-impact routines (such as walking or in-line skating) into your exercise regimen.

6 After returning from a break, easeback into sports. There’s a reasonprofessional athletes have preseason

training: it takes time for the body toadjust to heightened physical activity.If you ski, be sure to do some pre-conditioning to get ready to take onthe mountain, including incorporatingsome light weight training to gainstrength, and some moderate stretch-ing before you get on the lifts to en-hance flexibility.

With a little planning and variety, you canpursue the sports you love while being kindto your joints. n

Athletes: Cross-Train to Reduce Arthritis RiskAnil S. Ranawat, MD | Assistant Attending Orthopedic Surgeon, Sports Medicine and Shoulder ServiceAssistant Professor of Orthopedic Surgery, Weill Cornell Medical College

Encouraging people to get moving is a key component of the national osteoarthritisawareness campaign. But certain sports can increase the load on joints, raising therisk of osteoarthritis over time. So how do you get fit while protecting your hips, kneesand ankles?

4 | HealthConnection

• Being obese: Obesity is the leadingcause of osteoarthritis development andmakes pain worse in those who alreadyhave the disorder. The increased stresson your joints increases wear and tear.In addition, the proteins produced by fatcells might contribute to the develop-ment of inflammation in the joints. Los-ing just 10 pounds not only helps easeosteoarthritis pain, but can also helpslow the rate of cartilage degeneration.

• Being over age 65: The inevitable changesin tissue that accompany the agingprocess promote the development ofarthritis. Symptoms may begin in the 40’sand 50’s.

• Prior musculoskeletal injury: Any kind ofinjury to the bones, joints, and tendonscan raise your risk of osteoarthritis.Young athletes who sustain a sports in-jury may develop osteoarthritis earlier asadults. People who have been injuredneed to have regular check-ups and X-rays to keep a watchful eye on theirjoints. (See page 3 for more informationabout athletes and osteoarthritis.)

• Being female: About twice as manywomen as men suffer from osteoarthri-tis. While it is not completely clear whythere is this disparity, there are sometheories that exist. For more about os-teoarthritis in women, see page 6.

• Family history: If you have family mem-bers with osteoarthritis, you might, too;however, research to study geneticfactors related to osteoarthritis risk hasnot yet identified specific mutations

that commonly predispose individuals tothe disease.

You can assess your risk of osteoarthri-tis using the online Risk Assessment Tool lo-cated at www.fightarthritispain.org, in the“Resources” section. This web site, createdby the Arthritis Foundation, also providesguidance on how you can manage yourarthritis risk.

What Are the Symptoms?By far the most common symptom of os-teoarthritis is recurring joint pain. This painmay present in the following ways:

• Pain when you move the joint. Thesame joint hurts, especially duringweight-bearing activities, and lessenswhen you stop moving. Some people

also hear a crackling sound that occurswhen the joint moves.

• Pain and stiffness may be worse at cer-

tain times of day. Some people experi-ence their worst joint pain when theyfirst wake up, while others experiencemore discomfort at the end of the day.

• Limited range of motion. As os-teoarthritis progresses, the affectedjoints may lose their range of motion. In-flammation and swelling may develop,causing more pain.

Osteoarthritis symptoms may also differdepending on which joints are affected.People with arthritis in the hips may feel painin the groin, inner thigh and buttock, whichmay extend to the knee and cause limping.

Osteoarthritis through the years 30 40 50 60 70 80 90

s s s

This chart provides aglimpse at the

development of arthritisover time and risk

factors, symptoms, andtreatment related to its

progression.

Low RiskActive – Normal Body Mass Index

No joint discomfort

The best approach to keepingosteoarthritis at bay is to stayactive, participate in regularexercise, and practice good

nutrition to maintain a healthy weight.

Moderate RiskOverweight – Inactive –

Knee InjuryJoint pain, stiffness andlimitation of activities

Treatment includesmedications, joint

injections, regular exerciseand weight loss.

High RiskPersistent and severe pain

and disability

If the arthritis has progressed to a pointwhere daily living and/or recreationalactivities can no longer be performedwithout pain and walking is extremelydifficult, joint replacement surgery may

be the best option.

continued from page 1

continued on page 5

A Healthy Joint

In a healthy joint, the ends of bonesare covered with smooth cartilage andthe capsule encloses the joint, whichis encased in muscles and connectivetissues.

A Joint with Osteoarthritis

With osteoarthritis, the cartilage startsto break down and damage to thebone occurs. The result can be apainful joint and loss of mobility andfunction.

HealthConnection | 5

Knee arthritis may cause pain and a gratingor a catching feeling with movement. Os-teoarthritis in the fingers can cause pain,redness and swelling in the joints whichmake it difficult to pick things up. Some peo-ple with arthritis in the fingers develop bonygrowth spurs in the joints at the middle orends of the fingers.

Joint pain can be caused by a number ofdiseases. If you have experienced any ofthese symptoms, it is important to see a doc-tor to determine what is causing your symp-toms, so you can take measures to startmanaging them as early as possible.

Making the DiagnosisIf you have joint pain, your doctor will do aseries of examinations to determine thecause. The first is a physical examination tolook for any swelling and to assess yourlevel of pain, range of motion and muscle

strength. If your pain is in your knees orhips, your doctor may also look at how it isaffecting your walking (gait). It is importantto tell your doctor about your medical his-tory, such as prior injuries, and the natureof your pain.

X-rays can help visualize what is hap-pening inside a joint, particularly if any wear-ing-down of the bone has begun. They canalso be used to show cartilage deterioration,because the bones of a joint will move closertogether when this happens. Magnetic res-onance imaging (MRI) is very helpful fordemonstrating bone and soft-tissue changesin arthritis at an earlier stage, while com-puted tomography (CT) scanning is valuablefor assessing early bony changes, includingbone spurs.

In some patients with suspected os-teoarthritis, ultrasound is useful for imagingcysts. Your doctor may also do blood testsor withdraw some synovial fluid from a jointfor analysis to rule out other causes of jointpain and to confirm a diagnosis of os-teoarthritis.

What You Can DoIf you are at risk for developing osteoarthri-tis or are diagnosed with this condition, your

doctor will discuss ways you can reduceyour risk or slow its progression. By far themost effective and tangible way is to achieveand maintain a healthy weight, as well asstrengthen your joints and maintain flexibil-ity. See page 2 to learn how.

The management of osteoarthritis mayrequire a team approach, bringing togetheryour primary care physician, a rheumatolo-gist (joint specialist), sports medicine doc-tor, physiatrist (rehabilitation medicinespecialist), orthopedic surgeon, dietitianand/or physical therapist as needed.

Your health care team may recommendanti-inflammatory drugs such as ibuprofenor naproxen to manage your symptoms, orprescription drugs such as celecoxib. Somepatients benefit from joint injections or me-chanical adjustments that shift the pressurebeing put on a joint, such as custom or-thotics to be worn in your shoes to relievehip or knee pain.

If, despite these measures, joint damageand pain in the knees or hips become so se-vere that they significantly interfere with yourdaily activities, your health care team mayrecommend joint replacement to get youback to your normal routine as quickly andcomfortably as possible. n

Osteoarthritis is the nation’s

number one musculoskeletal

disorder.

continued from page 4

Your doctor will discuss ways

you can reduce your risk of

arthritis or slow its progression.

The most effective and tangible

way is to achieve and maintain

a healthy weight, as well as

strengthen your joints and

maintain flexibility.

6 | HealthConnection

What could account for these differences?There are a number of theories. By far themost important risk factor for osteoarthritis inwomen, as in men, is obesity. Women whogo through menopause often gain weight,and the increased stress on the joints may ex-plain the rise in osteoarthritis seen amongwomen after age 55. By the time a womanreaches 65, she istwice as likely as aman to experience os-teoarthritis symptoms.

Another possibleexplanation is anatom-ical: women’s hips arewider than men’s. Theangle formed by thehip bones being widerthan the knees putsmore stress on theoutside of the knees.This “knock-kneed”position, even if slight,can put stress on theoutside of the knees,causing osteoarthritis over time in somewomen.

Women are also more likely to develop acondition called “patellofemoral syndrome,”in which the kneecap (patella) does not glidesmoothly over the joint and rubs against thelower part of the thighbone (femur). Thismisalignment may be exacerbated by hy-perextended knees in women who wearhigh heels. The recurrent rubbing of thekneecap on the thighbone causes wear andtear that can progress to arthritis and causepain in the front of the knee.

The increased prevalence of osteoarthri-tis in women has also triggered studies to

determine the role of hormones. While theroles of hormones such as estrogen andprogesterone in osteoarthritis are unclear,research has shown that hormone replace-ment therapy (HRT) may have a protectiveeffect. The 1997 Chingford Study in Lon-don, for example, found that among morethan 1,000 women, those who used HRT

experienced less osteoarthritis of the knee(as seen on X-rays) and slightly less in thehands. Research exploring the influence ofhormones on osteoarthritis is continuing.

Other investigators have studied the roleof a hormone called relaxin, which is in-creased during pregnancy and makes jointsmore lax, causing potential instability. Ele-vated relaxin has been proposed as a possi-ble explanation for the increased prevalenceof osteoarthritis of the hands seen in womencompared with men. Studies are continuingto analyze this relationship.

Another theory relates to sports injuries.The increase in girls participating in high

school and college sports over the last coupleof decades means more females are experi-encing sports injuries, particularly tears to theanterior cruciate ligament (ACL) of the knee.This injury on its own places an individual atan increased risk of osteoarthritis, even if it issurgically repaired. Any instability in the kneegenerates wear and tear over time.

We could actually see an increase in os-teoarthritis in women in the coming years asgirls with ACL injuries grow up. One 2004study found that among female soccer play-ers who had sustained ACL injuries, more

than half developed X-ray signs of os-teoarthritis in the following 12 years.

So ladies, take precautions now to re-duce your risk of developing osteoarthritis(see page 2 to learn how) and to manage itwell if you already have it, including:

• Achieving and maintaining a healthyweight

• Incorporating exercise into your dailyactivities

• Staying strong and flexible to reduceyour risk of injury

• Seeing your doctor to determine thebest course of therapy if you are expe-riencing arthritis symptoms. n

When It Comes to Arthritis, It’s Ladies FirstMarci A. Goolsby, MD | Assistant Attending Physician, Women's Sports Medicine CenterInstructor of Medicine, Weill Cornell Medical College

Osteoarthritis is not an equal-opportunity disorder: It appears to favor women. Amongpeople with osteoarthritis, there are twice as many women as men, especially forthose with arthritis in the knees and hands. Symptoms typically begin to appear inwomen in their 40’s and 50’s, and the disparity becomes even greater after age 55,after women enter menopause.

HealthConnection | 7

Osteoarthritis (OA) currently costs our na-tion more than $128 billion in direct medicalcosts (such as joint replacement surgery andother medical care) and indirect costs (in-cluding missed work days and disability pay-ments). According to the U.S. Centers forDisease Control and Prevention (CDC), thatfigure could soar even higher as more peo-ple affected by the disease become unableto care for themselves or work.

This is precisely why, in early 2010, theArthritis Foundation and the Ad Councilteamed up to launch a national osteoarthritiscampaign. Called “Moving Is the Best Medi-cine,” the initiative was created to raise aware-ness of OA, increase public health education,and advocate for more funding for ground-breaking research for a disease that somepeople just don’t take seriously enough. Thenational campaign brings together the Arthri-tis Foundation with government organizationsthat are supporting and conducting os-teoarthritis research, such as the National In-stitutes of Health (NIH) and the CDC.

The National AgendaMany of the messages of the campaignfocus on what you can do to reduce yourrisk of arthritis or ease its symptoms if you al-ready have it — from embarking on an exer-cise program to adopting a healthy diet toachieve a healthy weight. As its first yearcomes to a close, the campaign has bench-marked its success, with increased aware-ness of OA nationwide promoted onbillboards, in TV and radio public service an-nouncements and in news stories.

The aim of the campaign’s secondphase is “Arthritis Pain Is Unacceptable,”with the goal to drive home the seriousnessof arthritis. It will urge people with joint painto see a rheumatologist to assess the causeof their symptoms and to secure the mostappropriate treatment. In addition, the OAadvocates are asking Congress to increaseresearch funding by 12 percent to the NIH,to support Department of Defense arthritisresearch programs with $8 million, and tosupport the CDC’s arthritis research effortswith an additional $10 million.

HSS: Leading in the CauseHospital for Special Surgery is a leader inclinical care and research in arthritis and iscontinuing its efforts to promote the OA na-

tional agenda. HSS’ multidisciplinary Os-teoarthritis Steering Council has directedseveral initiatives, including:

• HSS Osteoarthritis Summit: Frontiers

in OA Research, Prevention and Care

(June 17-18, 2011). This conferencewill bring together at HSS for the firsttime a comprehensive multidisciplinarygroup of world-renowned scientists,physicians and industry representa-tives from the United States, Canadaand Europe to discuss all aspects ofosteoarthritis and to develop a consen-sus document on future directions forresearch, prevention and treatment.The proceedings of the meeting will bepublished in the HSS Journal (theMusculoskeletal Journal of Hospital forSpecial Surgery, which publishes peer-reviewed articles that contribute to theadvancement of the knowledge ofmusculoskeletal diseases).

HSS Leads in Advancing the National Arthritis AgendaLaura Robbins, DSW Senior Vice President, Education & Academic AffairsDesignated Institutional Officer, GMEAssociate Scientist, Research DivisionAssociate Research Professor of Social Work in Medicine, Weill Cornell Medical College

There’s good reason to make osteoarthritis a national health priority: Its associationwith aging means it is expected to rise in prevalence, as increasing numbers of babyboomers reach their 60’s. It is expected to affect some 67 million adults in Americaby 2030 and is already the leading cause of disability, keeping otherwise healthypeople from living more productive lives.

continued on page 7A

HealthConnection | 7A

• State of the Science in the Prevention &

Management of Osteoarthritis (July 14-

15, 2011). This conference is designedfor nurses who are often the first pointof contact for patients. This will be a con-sensus workshop of experts fromaround the country. Partnering with theAmerican Journal of Nursing, the meet-ing will result in a special issue of thejournal, reaching over 10,000 nurses toeducate them about OA and their role inhelping patients with the disease.

• Ongoing evidence-based community

wellness and early intervention pro-

grams, from t’ai chi, yoga and Pilates toour annual Osteoarthritis Seminar andArthritis Foundation Lifestyle Manage-ment Program. See chart at right formore information.

• Partnering with community organiza-

tions to promote early intervention and

teach community-based groups about

osteoarthritis. One example is a key part-nership with the Retired Teachers Asso-ciation of the United Federation ofTeachers on Osteoarthritis Prevention.

As part of our Community Service Plan (astrategic plan required of all New York Statehospitals), health professionals are assessingthe needs of our communities, with a majoremphasis on OA and other musculoskeletaldiseases. Most recently, we launched our OAweb site with updated information. Check itout at www.hss.edu/osteoarthritis.

Osteoarthritis is an enormous socioeco-nomic burden on our society. As consumersand patients, there are steps we can all taketo lessen that burden for individuals, com-munities and the nation as a whole.

For more information, visit www.hss.edu/

osteoarthritis or www.fightarthritispain.org. n

continued from page 7

Programs and Resources

Hospital for Special Surgery offers the following classes to help you gainendurance, strength and flexibility and reduce your osteoarthritis risk:

Better Balance for Older Adults: Unique exercises selected for individuals who wouldlike to increase their balance control and decrease the risk of falls.

Exercises for Older Adults with Osteoarthritis: Exercise for osteoarthritis has beenshown to strengthen the muscular support around the affected joints while preventingthe joints from “freezing up,” improving and maintaining joint mobility.

Osteoarthritis Seminar: A full day program bringing together clinical experts to dis-cuss osteoarthritis management through nutrition, exercise, pain management andtreatment options.

Gentle Yoga: The slow, controlled physical movement of yoga can provide pain relief,relax stiff muscles, ease sore joints and help build strength.

Pilates: A series of specific movements designed to strengthen the powerhouse muscles of the abdomen, back and waist.

Yogalates: A popular form of exercise that blends the best of yoga and Pilates.

T’ai Chi Chih: Simple, rhythmic movements that provide benefits such as improvedbalance, strength, flexibility and maintenance of bone mass.

Dance for Fitness and Fun: Studies have shown that dance maintains cardiovascularfitness, enhances emotional well-being, strengthens weight-bearing bones, and slowsloss of bone mass.

For more information on the schedule, location and cost of these classes, visitwww.hss.edu/pped or call 212.774.2793.

Integrative Care Center (ICC): The ICC, located in mid-Manhattan and affiliated withHospital for Special Surgery, offers movement and exercise group classes such asOsteoFitness, Back to Basics, therapeutic yoga, Pilates and T’ai Chi Chih®. Pleasevisit www.hss.edu/ic for more information on Winter/Spring 2011 class offerings orcall 212.224.7900.

Other resources:

Arthritis Foundation: www.arthritis.org Arthritis Foundation and Ad Council: www.fightarthritispain.orgArthritis Today magazine: www.arthritistoday.orgNational Institute of Arthritis and Musculoskeletal and Skin Diseases:www.niams.nih.govU.S. Centers for Disease Control and Prevention: www.cdc.gov/arthritis/basics/osteoarthritis.htm

HealthConnection | 7B

tion and the Ad Council, and supported byHospital for Special Surgery. It’s aptlynamed: Regular physical activity is essentialto both prevent and manage osteoarthritis,and for good reason:

• Regular exercise helps facilitate weightloss, especially if you’re following ahealthy diet.

• Exercises to strengthen muscles gen-erate more support for your joints.

• Gentle stretching exercises keep jointsflexible and increase range of motion,reducing the risk of injury.

Aim for 30 to 45 minutes of exercise atleast three times a week — ideally a com-bination of cardiovascular, strengtheningand stretching exercises. Before embark-ing on any new exercise program, be sureto check with your doctor to determinewhat types of exercise are best for you,and any special precautions you may needto take.

Here are some ideas to get you started:• Walking: This is the easiest exercise and

can be done just about anywhere. Besure to wear comfortable, supportiveshoes. If you live in a city, you canleisurely walk its parks. For those wholive near malls, many malls open theirdoors early so people can come in andwalk in a comfortable environment. Mall-walking groups also provide a social ele-

ment for people who don’t have familyclose by or others with whom to exercise.

• Aquatics: Look for a water aerobicsclass. Exercising in water reducesstress on the joints and is not associ-ated with a risk of falling.

• Get on a recumbent bike: These bicy-cles enable you to cycle in a comfort-able position and help increase yourendurance, flexibility and leg strength—all in one exercise.

• Take a class in gentle yoga, dance, or

t’ai chi: These exercises have toning,flexibility and relaxation benefits. Plusthere’s the added advantage of the“shared energy” in these classes as youbend and move with your classmates.

• Take the stairs: Not all exercise requiresa formal workout. Take the stairs insteadof the elevator; get off the subway or busone stop earlier and walk the rest of theway; or park a little farther out at the mallto burn a few extra calories and get yourheart pumping.

Step 3: Be Careful!Joints that have been injured have a greaterrisk of developing osteoarthritis over time. Soas you move to a more active lifestyle, takethese precautions to reduce your risk of injury:• Warm up and cool down. Be sure to

stretch gently both before and after anyexercise program.

• Lift weights. Incorporate resistance exer-cises, such as gentle weight training, intoyour exercise routine to strengthen themuscles around your joints. The extrasupport will reduce your risk of injury.• Watch your step. Take simple precau-

tions to prevent falls, like watching yourstep if you’re walking when it’s rainy oricy outside.

Above all, find an exercise program thatworks for you. The more you like it, the eas-ier it will be to stick with it!

For information on nutritional guidance pro-vided by Hospital for Special Surgery, con-tact the Department of Food and NutritionServices at 212.606.1293. For informationon exercise classes, see page 7A. n

Weight loss is best sustained

when the weight is lost

gradually. Aim to lose one to two

pounds per week. It may have

taken you years to accumulate

those pounds, so don’t be

surprised if it take several

months to lose them. Likewise,

don’t expect your diet to change

overnight. Start by looking at

what you are eating now (keeping

a food diary is a great way to do

this) and identifying areas where

you can improve. Little steps

along the way will add up to big

results over time.

continued from page 2

535 East 70th StreetNew York, NY 10021

Specialists in Mobility

HOSPITAL FOR SPECIAL SURGERY

For more information visitwww.hss.edu or to make an appointment call our Physician Referral Service at 800.796.0486.

Public and Patient Education Department212.606.1057www.hss.edu/pped

Research Division212.774.7123www.hss.edu/researchwww.hss.edu/osteoarthritis-researchwww.hss.edu/clinical-trials

Additional resources:Arthritis Foundationwww.fightarthritispain.org

MedlinePluswww.medlineplus.gov

National Institutes of Healthwww.nih.govwww.clinicaltrials.gov

New York State Osteoporosis Prevention & Education Programwww.nysopep.orgHSS Regional NYSOPEP Center212.774.7314

The Education Division’s Public and Patient Education Department provides information to the general public and patients through a variety of health educationprograms. Professionals provide practical information to help prevent or manageorthopedic and rheumatological conditions. Programs are held at the hospital aswell as in the community. The department is dedicated to providing educationtoday, so that everyone can have a healthier tomorrow.

HealthConnection is published by the Education Division at Hospital for SpecialSurgery as a service to the general public and patients. For further information regarding material contained in this newsletter or inquiries on how to obtain additional copies contact:

Public and Patient Education DepartmentEducation & Academic Affairstel: 212.606.1057 | fax: 212.734.3833pped@hss.edu

All rights reserved. ©2011 Hospital for Special Surgery

Community Service Plan 2010-12: Advancing the Prevention Agendafor Public HealthThe 2010-12 Community Service Plan provides a concise overview of Hos-pital for Special Surgery’s initiatives that help improve the health, mobility,and quality of life for the communities it serves. Visit www.hss.edu/commu-nity for more information and to download a copy of the hospital’s plan.

Specific outreach goals for osteoarthritis (OA) awareness and intervention are:

• Increase public awareness of OA as a priority health concern• Educate the public about the spectrum of treatment options for OA• Help people with OA to increase their knowledge of the disease• Offer people with OA strategies for disease management • Implement OA lifestyle and behavior management programs.

Non-Profit Org.U.S. Postage PaidNew Britain, CTPermit No. XX

Hospital for Special Surgery is an affiliate ofNewYork-Presbyterian Healthcare Systemand Weill Cornell Medical College.

Hospital for Special Surgery is aparticipating organization of theBone and Joint Decade.

Affiliated Offices:Hospital for Special Surgery offerspremier health care services in yourcommunity. Contact our affiliatedphysician offices for more information.

New YorkFresh Meadows718.591.7090

Uniondale516.222.8881

ConnecticutGreenwich Office203.409.3000

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Education & Academic AffairsPrograms PromotingMusculoskeletal Health

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Laura Robbins, DSWSenior Vice President, Education & Academic AffairsAssociate Scientist, Research DivisionDesignated Institutional Officer, GME

Edward C. Jones, MD, MAAssistant Attending Orthopedic SurgeonMedical Editor

Marcia EnnisDirector, Education Publications andCommunicationsManaging Editor

Sandra Goldsmith, MA, MS, RDDirector, Public and Patient Education

Jalak Patel, MSAssociate, Public and Patient Education

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